Provider Demographics
NPI:1174646236
Name:NICHOLS, DEBORAH H (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:H
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 RAINES CT
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6268
Mailing Address - Country:US
Mailing Address - Phone:850-478-6100
Mailing Address - Fax:
Practice Address - Street 1:3165 RAINES CT
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6268
Practice Address - Country:US
Practice Address - Phone:850-478-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist